P1629 - Evaluation of the Relationship Between COVID-19 Severity and Serum Biologic Level in Inflammatory Bowel Disease Patients

Jeremy Van, DO, Netanel Zilberstein, MD, Tavia Buysse, MD, Jamie King, MPH, Ioannis Economou, MD
Rush University Medical Center, Chicago, IL

Introduction: Studies suggest a protective effect of biologic therapy (BT) from severe Coronavirus 19 (COVID-19) in inflammatory bowel disease (IBD) patients (pts). However, studies are lacking on the impact of BT intake timing on COVID-19 disease course. This study aims to evaluate the relationship between COVID-19 severity and serum biologic level in IBD pts.

Methods: Crohn’s Disease (CD) and Ulcerative Colitis (UC) pts on BT, from an academic medical center that tested COVID-19 positive from 3/1/2020 to 3/14/2021, were included. Comorbidities including obesity, type II diabetes, COPD, smoking history, and chronic kidney disease were documented. The interval between last BT intake and COVID-19 diagnosis (dx) was recorded. The biologic half-life (HL), used as a surrogate marker for serum drug level, for infliximab/biosimilar, adalimumab, natalizumab, ustekinumab, and vedolizumab was 9.5, 14, 16, 19, and 25 days, respectively. COVID-19 severity was defined as mild if managed outpatient or in the emergency room, and moderate (mod)/severe if requiring hospitalization, intensive care unit admission or resulting in death. Mann Whitney U test was used for continuous variables.

Results: 37 (28 CD, 9 UC) pts, 20 females and 17 males were identified. Median age, BMI, and number of comorbidities were 43, 30.5, and 1, respectively. Of the patients on biologics, 1 was on natalizumab, 3 on vedolizumab, 5 on ustekinumab, 11 on adalimumab, and 17 on infliximab/biosimilar. No pt was on concomitant steroid therapy. Mild and mod/severe outcomes were seen in 32 and 5 pts, respectively. No deaths were reported. The mean interval between drug intake and COVID 19 dx was 1.5 HL in mild and 2 HL in mod/severe COVID-19 pts. There was no significant association between timing of BT and COVID-19 severity in patients on BT (p=0.98), those on anti-TNFs alone (p=0.75), and those on ustekinumab alone (p=0.54).

Discussion: There is no association between severity of COVID-19 and timing of BT in IBD pts suggesting no detrimental effect of biologics on the COVID-19 disease course. The small number of pts with mod/severe outcomes suggests a protective effect. Future studies are needed to further evaluate the relationship between serum biologic levels and COVID-19 severity.

Moderate/Severe COVID-19 pts

Biologic Therapy	(a)White pts (Nr.)	(b)Black/Hispanic pts (Nr.)	(c)UC pts	(d)CD pts	(e)Age	(f)Infliximab/biosimilar 5mg/kg	(g)Infliximab/biosimilar 10mg/kg	(h)Dosing Frequency	(i)Interval (avg Nr. of biologic HL)
Infliximab/biosimilar	0	1	0	1	67	1	0	q8 weeks	4.3
Adalimumab	1	0	1	0	42	(j) N/A	N/A	q2 weeks	0.5
Ustekinumab	0	2	0	2	42	N/A	N/A	q8 weeks	1.5
Vedolizumab	0	1	0	1	61	N/A	N/A	q8 weeks	1.5
Mean									2

Mild COVID-19 pts

Infliximab/biosimilar	8	8	4	12	43	11	5	q8 weeks	4.3
Adalimumab	9	1	2	8	37	N/A	N/A	q2 weeks	1
Ustekinumab	2	1	0	3	37	N/A	N/A	q4 weeks	1.2
Vedolizumab	0	2	2	0	46	N/A	N/A	q8 weeks	0.6
Natalizumab	0	1	0	1	40	N/A	N/A	q6 weeks	0.4
Mean									1.5

Table: a: number of white patients
b: number of black and hispanic patients
c: number of patients with Ulcerative Colitis
d: number of patients with Crohn's Disease
e: Average age in years
f: number of patients on 5mg/kg dosing
g: number of patients on 10mg/kg dosing
h: median dosing frequency
i: Average number of biologic half lives between the patient's last biologic intake and COVID-19 diagnosis
j: Not available





Disclosures:
Jeremy Van indicated no relevant financial relationships.
Netanel Zilberstein indicated no relevant financial relationships.
Tavia Buysse indicated no relevant financial relationships.
Jamie King indicated no relevant financial relationships.
Ioannis Economou indicated no relevant financial relationships.


Jeremy Van, DO, Netanel Zilberstein, MD, Tavia Buysse, MD, Jamie King, MPH, Ioannis Economou, MD. P1629 - Evaluation of the Relationship Between COVID-19 Severity and Serum Biologic Level in Inflammatory Bowel Disease Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.